Effectiveness of sterilization of retained bone debris in orthopaedic instruments

Retained debris found in reusable surgical instruments during total joint arthroplasty raises concern for sterility. Like reusable surgical instruments, such debris undergoes autoclave sterilization, implying it may also be sterile. However, prior literature has failed to reach a consensus. This prospective cohort study included 25 patients with aspirate-confirmed hip or knee prosthetic joint infection (PJI) and 25 patients without infection. Intraoperative bone and tissue specimens were obtained from both cohorts, and seven random cement cultures were obtained. All specimens underwent standard autoclave sterilization followed by aerobic, anaerobic, fungal and acid-fast bacilli (AFB) culture. Among patients with PJI (N = 18 knee, 7 hip), preoperative aspiration cultures identified Staphylococcus in 23 cases (18 methicillin-sensitive, 5 methicillin-resistant), Escherichia coli in one, and Pasteurella multocida in one. Intraoperative cultures matched preoperative aspirates in all cases. After sterilization, all bone and tissue specimens obtained from patients with known PJI were negative for aerobic, anaerobic, fungal and AFB. Of the seven cement specimens (three from patients with PJI and four from control group), all were negative after sterilization. All control cultures were negative. Autoclave sterilization appears effective in eliminating bacteria, fungi and mycobacteria from previously infected specimens, suggesting the potential safety of using surgical instruments with retained debris for total joint arthroplasty. III